Single payer and details

Margot Sanger Katz at the New York Times raises a critical point about Democratic goals for single payer plans:

Like “repeal and replace,” “single-payer” is a broadly popular slogan that papers over intraparty disagreements and wrenching policy choices. Republicans fumbled multiple attempts to replace the Affordable Care Act this year. If the Democrats eventually wrested back power, they could find themselves similarly factionalized and stymied over the details.

Rep. Conyers has released a set of single payer bills.  Senator Sanders is scheduled to release a single payer bill tomorrow.  These bills have no chance of becoming law in this session of Congress.  Yet they serve a good purpose in building consensus that originates from the intra-party consensus on universal coverage towards the mechanics of achieving that goal.

But the details matter. While it is true, as advocates often mention, that much of the world has some form of universal health care, there is wide variation in how those systems work. Nearly any single-payer plan would require substantial disruptions in the current health care system, upending the insurance arrangements of the 156 million Americans who get their coverage from work, changing the way doctors, hospitals and drug companies are paid, and shifting more health care spending onto the government ledger. Such a proposal would reshuffle the winners and losers in our current system.

If there is going to be a legitimate single payer push the next time there are working and functional universal coverage majorities in Congress, then the details matter.  And those details need to be fleshed out.  The first drafts (and that is what these bills are) need to be ruthlessly  edited.  They need experts to look at Section 1422-a-2-b and say that it does not align with Section 332-b nor does it play nicely with established case law and business practices.  These drafts need experts to ask if the implied trade-off is actually the trade-off that is intended to be made.  These drafts need to be ripped apart for internal weakness and stress tested against plausible events and corner cases.

If people are serious about wanting to move towards some type of single payer system anchored on Medicare as the means towards achieving universality, then the hard work of figuring out how to make things work is needed now.  If you want a slogan, than it is fine to be lazy.

145 replies
  1. 1
    Baud says:

    I nominate David to be the single payer.

  2. 2
    Barbara says:

    I think working on the details sooner rather than later is a good idea. What bothers me most are people who basically know nothing about Medicare assuming that it provides the best model for universal access to health care.

  3. 3
    JCJ says:

    Would it be at all possible to outsource the development of a universal coverage system to Germany or the Netherlands or some other country? Does it have to be developed from scratch? I doubt there will ever be majorities available for “single payer.” Your writing about the actuarial value of Medicare should be required reading for any politician pushing “single payer.”

  4. 4
    Bailey says:

    I don’t have great insight into the bill writing process, the types of experts used to draft the current bills being proposed, or even what the stress testing of the proposed legislation looks like, but is there any reason to think that currently legislators are approaching this in a lazy fashion?

  5. 5
    Redshift says:

    @Baud: I suspect the Secretary Saying No will be a very unpopular figure in the Baud Administration.

  6. 6
    🌷 Martin says:

    Democrats would be better off not worrying too much about national single payer efforts and instead see if they can get California over the finish line and using that as a laboratory for what might work nationally. This is a state they don’t need to worry about winning seats, so they should be focusing on winning policy.

  7. 7
    jl says:

    @Redshift: I always thought ‘Never Say No’ was the main plank in the Baud platform.

  8. 8
    SatanicPanic says:

    @🌷 Martin: This. 100% this. We can do it here, but we need to get serious.

  9. 9
    Elie says:

    I am sure that I am in the minority but I think that trying to jump to Medicare for all in one leap is politically unfeasible. I think we will need to “back into” single payer from a platform such as ACA — which we will be lucky to keep given all that is being done to undermine its financial stability. Rather than “single payer”, what I want is health care coverage for all. That might mean a variety of arrangements from a core “Medicare for all” minimum package with purchased add on frills as separate insurance plans. That has the benefit of keeping some sort of insurance market alive rather than trying to completely move over to full government payment — which I just don’t see happening easily – if at all. Lots of “good” countries have a variety of tools to achieve universal coverage from Canada where each state is the payer, to Germany where there is a private insurance add on you can purchase. UK has the single payer state plan but also private add ons.

    Please remember this: This is very, very expensive — the changeover and the coverage for all in the future. Like it or not we are an ageing population with a smaller and smaller group of younger people paying for the big senior group. This is happening all over the west (Europe) as well as China. Any country with a population ageing faster than our youngs, is facing this. Our productivity (having money to do shit) economically is being challenged by those unarguable demographic realities. So those who want the magic fairy single payer, coverage for all for all types of health care utilization, need to face this. The price tag will be staggering if we try to do this anyway but incrementally, IMO.

  10. 10
    jeffreyw says:

    Sahil Kapur @sahilkapur
    NEW: Joe Manchin (D-WV) says Congress should explore a single payer health care system.

  11. 11

    @🌷 Martin: California if it was to do single payer needs massive ERISA waivers, needs incredible Medicaid waivers, needs never even imagined IRS and Medicare waivers.

    Single payer in a single state is probably functionally a bigger lift than federalized single payer.

  12. 12

    @Elie: Join the club — I care far more about universality than any particular finance mechanism.

  13. 13
    jl says:

    There are reforms that could improve current system, and make transition to single payer smoother, if country decides to go that way.
    Separation of insurance market into one very highly regulated one for a basic comprehensive mandatory policy, and a separate less regulated market for supplemental insurance for people who want additional benefits would be one. Some people won’t like that because they think it makes a two-tiered system more likely, but the two-tier threat will always be there, and most European countries have fond that the best way to control that threat.

    Another would be incremental reforms to chip away at regional insurance company and provider oligopoly market power. Setting up industry wide bargaining units that cut across market regions might be one approach.

    There are interim reforms that would make things work better regardless of whether we go Canada, or go France, or go Swiss or go Australia.

    Edit: and given the way the debate here seems to be evolving towards a choice between Go Swiss and Go Australia (premier Medicare for All country) a study of how they did it would be useful for lessons. Both countries had long hard fought struggles to get current systems, both of which controlled costs far better than here (but not enough to make either of those coutnries totally happy) and made big improvements to both countries’ population health.

  14. 14
    dr. bloor says:

    @Bailey:

    is there any reason to think that currently legislators are approaching this in a lazy fashion?

    We’ll know when we see if Bernie et al deliver a reasonable facsimile of a “bill” with anything vaguely resembling legislative heft to Congress, or the Powerpoint version of his editorial interview with the NY Daily News during last year’s primary.

    Like others, I’d like to see the mantra shifted from “Single Payer” to “Universal Coverage,” but it seems that ship has sailed.

  15. 15
    Yutsano says:

    @ Martin: @SatanicPanic: Didn’t it get pulled because it conflicted with the law saying certain funding has to go to education? It wasn’t will from what I understand, it was that the Senate couldn’t find a way around that.

    (Or is that just the official excuse?)

  16. 16
    dmsilev says:

    @🌷 Martin: For the California single-payer proposal to work, there would have to be significant federal buy-in to allow the experiment to go forward. That’s putting aside the …not fully fleshed-out nature of the current proposal.

  17. 17
    Barbara says:

    @🌷 Martin: As I have tried to explain to many people, the fragmentation of our system makes it very difficult for any state, even one as large as California, to adopt a true single payer model, certainly not without federal legislation. The best models we have are in Massachusetts and Hawaii, which are not single payer but do come close to universal coverage.

  18. 18
    Baud says:

    @jeffreyw: That’s great, but since it’s West Virginia, his constituents probably care more about the name Obamacare than the actual details of the plan.

  19. 19

    @David Anderson:

    Single payer in a single state is probably functionally a bigger lift than federalized single payer.

    Yup.

  20. 20
    Bailey says:

    @dr. bloor:

    We’ll know when we see if Bernie et al deliver a reasonable facsimile of a “bill” with anything vaguely resembling legislative heft to Congress, or the Powerpoint version of his editorial interview with the NY Daily News during last year’s primary.

    Like others, I’d like to see the mantra shifted from “Single Payer” to “Universal Coverage,” but it seems that ship has sailed.

    Thus far we’ve got nearly a dozen other Dem Senators signing onto Sanders’ particular version. While I would agree with the OP that this is just a first step with single-payer legislation that will need much refining. But I’m just wondering how anyone could know whether or not it was a lazy approach? Are these particular senators known for being lazy?

  21. 21
    Betty Cracker says:

    @Elie: I believe the millennial generation is even more numerous than the boomers. Not saying that solves all our problems. But when I was a young adult, there was a lot of talk about how we’d have to slash government programs once boomers started accessing them because Gen X was so much smaller. Not sure that argument still holds water.

  22. 22
    jl says:

    @Barbara: Maryland is a good state for transparent pricing for acute hospital care.

    I think studies of countries and individual states who are doing something well is needed.

    A country that survived adopting the Australian ballot and managed to keep its national identity can take the risk of studying the strange ways of foreign cultures like Hawaii and Australia and Switzerland.

    Though I see that reactionaries are floating the idea of another Go Swiss bait-and-switch campaign. As Krugman puts it, advertise the successes of Switzerland and adopt all the decentralized free enterprise parts, and strip out everything else that makes it work well, and basically con the US into going back to the pre PPACA system.

  23. 23
    Elie says:

    @David Anderson:

    I am hoping that folks begin to see that as the goal rather than the knee jerk “Medicare for All” mantra. I know that its catchy and sounds like a nice slogan that everyone understands, but it is very misleading by making people think its just an easy solution. The political and therefore economic steps necessary to accomplish it are about like sending a rocket to Mars. Lots of steps into a lot of political hazard. I just heard about how the Democrats need to fix our political success at the state and local levels. We will blow that up quick if we propose something that we know people will freak out with when they see the bottom line. We have to ease into this. Pelosi is damned right. Lets stabilize ACA and lean into building it out now that people know what THAT is and generally support it without adding 6 tons of expense right away. People also forget that we lost all those House seats after ACA passed. Not a reason not do something but lets look at this with clear eyes on the political cost. Let us not all follow the drum beat of Medicare for all over the cliff… we need to use our heads.

  24. 24
    SatanicPanic says:

    @David Anderson: Wouldn’t this depend on who the president is? If it’s President Harris wouldn’t we be in the clear?

  25. 25
    Yutsano says:

    @Barbara: The Hawai’i employer mandate law has the advantage of being grandfathered in before ERISA. It’s also why Hawai’i has gotten the biggest bang from the expansion of Medicaid and (I think) has one of the lowest uninsured rates in the nation. If they could manage to fund the rest they could probably get 98% coverage by something close to an expansion of the Medicaid system with an expanded payout.

  26. 26
    Uncle Ebeneezer says:

    I’m glad to see the Dem Party embracing this idea, but what troubles me is what will happen when “Medicare4All” or “SinglePayer” becomes a litmus test for 2018 and any candidate who favors a different route, more information/research etc., gets immediately labeled a Neo-Liberal Sellout our Big Pharma Shill. I’m already seeing this in CA, directed at any state official showing any caution on the Single Payer bill.

    Do we know if “Medicare For All” actually resonates better than “Universal Coverage?” To me the latter is better as it is more honest and open to other paths.

    Will the CBO do an analysis on Bernie’s proposal?

  27. 27
    SatanicPanic says:

    @Yutsano: I believe so. I don’t think it addressed funding much, if at all. It was a good first step, but wasn’t a real workable bill IMHO.

  28. 28
    Barbara says:

    @jl: Maryland does indeed serve as a good model not for transparent pricing so much as for equal hospital pricing that does not depend on payer class.

  29. 29
    Elie says:

    @Betty Cracker:

    Sorry, its true, particularly since immigration has been jammed. Immigration was the way that the US used to get around the demographic bomb. I will need to look up the stats, but I am pretty sure that there are not more of them than the olds they will need to support —

  30. 30
    jl says:

    @Yutsano: Thanks for mentioning ERISA. Revisiting ERISA is also important. It is becoming an archaic straight jacket.

  31. 31
    trollhattan says:

    I checked, “Single-Payer” fits on a hat. It’s going to work!

  32. 32
    jl says:

    @Elie: Best way to deal with the boomer bulge is to move towards more reform. PPACA has done more to fund affordable and adequate care for boomers and following generations than all the reactionary proposals put together, because most of them amount to yelling “Cut benefits now to solve the problem of having to cut benefits later.” while retaining all the inefficiencies of the status quo that pad various big interest groups’ pockets.

  33. 33
    SatanicPanic says:

    @Uncle Ebeneezer: Is this the worst thing though? Why not just say “I support single payer” and move on?

  34. 34
    jl says:

    @Barbara: I look at it as edging towards transparent pricing by other means. But it has been years since I worked with their acute care inpatient data sets, so I may be out of date on how the systems has evolved.

  35. 35
    Elie says:

    @Betty Cracker:

    Turns out we are both right from this Pew article:

    “Millennials are the United States’ largest living generation. In 2016, there were an estimated 79.8 million Millennials (ages 18 to 35 in that year) compared with 74.1 million Baby Boomers (ages 52 to 70). The Millennial population is expected to continue growing until 2036 as a result of immigration

    It is very necessary to stop the anti-immigrant BS real soon if we want to have our social safety net stay intact (or grow it)

  36. 36
    Elie says:

    @SatanicPanic:

    It is bad cause it locks you into a solution that may not work! We want everyone covered! That is the most important and central goal. Who pays or that there is just one payer is a red herring. The payer could be each state or a mixture of the Feds and state and some private insurance packages. We have to be flexible, but the goal is covering everybody, NOT having just one payer!!!!

  37. 37
    Cacti says:

    @Uncle Ebeneezer:

    Do we know if “Medicare For All” actually resonates better than “Universal Coverage?” To me the latter is better as it is more honest and open to other paths.

    I think “Medicare For All” as a slogan is actually easier for opponents to demagogue with current beneficiaries.

    I can see it now: “Medicare for everyone else means less Medicare for you.” Doesn’t matter if it’s actually true. It would be easy to make seniors believe it.

  38. 38
    jl says:

    As for litmus tests and buzzwords, seems like S*****s can live with single payer, or Medicare for All, and the bottom line is ‘health care is a right’ which seems to be the bottom line litmus test. So, you got three choices for a litmus test and you can fit almost anything that works around the world under one of those three.

    And a big difference between Democratic evolution towards their vague litmus test buzzwords and GOP is that we have vague litmus test buzzwords for a variety of things that will work, and they had one litmus test buzzword for toxic nonsense that would not work, and not meet their promises to the voters. That is a very big difference.

    So, I’ll take current Dem situation any day over the GOP’s.

  39. 39
    SatanicPanic says:

    @Elie: Do people really know what Single Payer means though? I feel like we could finesse that. Plenty of countries have government as the primary insurance provider, but with some private plans. I believe we still call that single payer.

  40. 40
    tobie says:

    @Elie:

    Germany where there is a private insurance add on

    This is simply untrue. Most people in Germany get their health insurance through their employer. Period. These are private plans. Individuals can also purchase insurance and they have a choice of public and private plans. Subsidies depend on income-level. If this sounds a lot like Obamacare, it is because it is the model for Obamacare. What would help is if we would implement the consumer protections that the German system has.

  41. 41

    I’m still not convinced that single-payer is necessarily more desirable than a public option, despite being well to the left of basically all elected Democrats. The thing is, there’s something to be said for not subjecting people to unwanted changes. If we change to single-payer, a lot of people are going to get changes to their healthcare that they didn’t ask for, and they may not like all of them. The public option would allow people to keep their coverage if they like it and buy into Medicare (or Medicaid) if they don’t – and merely having that option available would force private insurers to improve their coverage and efficiency in order to stay competitive.

    I realise a lot of people just want to get rid of private insurers entirely, and I sympathise with the impulse, but firstly, I’m not sure it’s possible (I doubt the Supreme Court would leave a bill that did this intact, even if we could pass one), and secondly, I’m not sure it’s smart politics (I may be a leftist, but I’m also a pragmatist).

    The party seems to have jumped on the single-payer bandwagon without much discussion of alternative paths to universal coverage, and I’m not sure that’s a good thing. Many countries have universal coverage without single-payer, and I think there’s something to be said for a system like Germany’s, which offers consumers a lot of choices while keeping prices under control and subsidising care for those who can’t afford it.

    “Medicare for all” is a catchy slogan, but I’m afraid that when people start hearing the specifics of what it entails, they won’t like it. “Medicare for all who want it” seems like the better path to go down.

  42. 42
    jl says:

    @SatanicPanic: The term single payer is almost meaningless. Systems as different as Canada to the Netherlands have been callled ‘single payer’ by health economists and fiscal analysts. If a politician cannot sell one of a very wide variety of good and workable systems as ‘single payer’, that means that politician is not working with a competent health economists who can explain how to sell it.

  43. 43
    gene108 says:

    A lot of liberals want single-payer, as a way to destroy the for-profit healthcare industry, such as for profit health insurance. They want a socialist state and this is a means to an end.

    Others think it’s a good way to get everyone universal coverage, but a lot of single-payer advocates really do want to destroy the capitalist system, from what I read on other liberal blogs.

  44. 44
    Yutsano says:

    @jl: You can’t do single payer anywhere without reforming ERISA or just scrapping it entirely. Maybe do an expansion of HIPAA that covers this.

    Side note: seems like once a decade we ass a major law regarding our health system that only seems to fix one minor detail.

  45. 45
    gene108 says:

    A lot of liberals want single-payer, as a way to destroy the for-profit healthcare industry, such as for profit health insurance. They want a soc$alist state and this is a means to an end.

    Others think it’s a good way to get everyone universal coverage, but a lot of single-payer advocates really do want to destroy the capitalist system, from what I read on other liberal blogs.

  46. 46
    germy says:

    Since whatever the democrats propose will be picked over and amended by republicans, isn’t it better to start off with something really progressive. So then by the time a law finally gets passed, it’ll be closer to what everyone here is talking about?

  47. 47
    Elie says:

    @SatanicPanic:

    Wishy Washy talk during a campaign must eventually give way to very specific legislation that will have to support what you actually mean. And that is where things get very very hard for “Medicare for all” or “single payer”. You would have to be prepared to figure out what to do with the employer market as well as the insurance market in general and then transfer a lot of dough around to Uncle Sam (which would go over quite well, doncha think?). No, we are going to have to finesse actually doing this …. and it won’t be easy…

  48. 48
    Uncle Ebeneezer says:

    @(((CassandraLeo))): Co-Sign, in full. Exactly. “Repeal & Replace” was also a catchy slogan…

  49. 49
    chopper says:

    i’m happy seeing such a push for single-payer but i don’t trust anything sanders puts forward to have enough detail to pass muster.

  50. 50
    Baud says:

    @germy: Propose something too far to the left and it’s dismissed out of hand and the momentum dies.

  51. 51
    Elie says:

    @tobie:

    Okay — you got me on the details of how. But the thought I was trying to illustrate remains true — countries use different vehicles for universal coverage. It is not all single government payer…

  52. 52
    FlipYrWhig says:

    @SatanicPanic: That’s the whole problem with “Single Payer.” It’s two words, neither of which explain WHO DOES THE FUCKING PAYING. It’s about the worst political phrase in the history of political phrases. It’s like that terrible “bada-book, bada-boom” commercial, where they then have to explain why the phrase means anything, because it doesn’t.

    Or it’s like how the French word for “bat,” as in the animal, is “chauve-souris.” So when the French were coming up with the key attributes of a bat they figured, hmm, I guess the important feature of a bat is that it’s a mouse (souris) that’s bald (chauve). Not that IT FUCKING FLIES, but that it’s bald. Which it isn’t.

  53. 53

    @gene108: Yeah, I don’t pay attention to those people, I barely even trust them as temporary allies. Then again, I’m a horrible person who thinks that capitalism can be useful for many things.

  54. 54
    Baud says:

    @chopper: There’s no way the proposed bill will be complete. This is just a starting point.

  55. 55
    gene108 says:

    @dr. bloor:

    We’ll know when we see if Bernie et al

    I think the “et al” of other Senate Democrats jumping on board can deliver a comprehensive draft. There are still people in the Senate and House, who were around, when Obamacare was crafted, when Dodd-Frank was made into law, and therefore should still have the staff needed to undertake a complex piece of legislation.

    Personally, I think everyone gets some basic form of Medicare as a right, and then uses it as a supplemental insurance to back up gaps in private insurance or the other way around.

    That’s be the simplest way to get to Medicare-for-all in one giant step, without destroying the current system.

  56. 56
    SatanicPanic says:

    @Elie: Sure, but that’s all stuff we’ll have to do anyway, we’re just arguing over what to call the thing we want to do, and single payer is a notably vague term. Why not just have everyone call it that? I guess my broader point is why Democrats feel compelled to be nitpicky and insist on doing everything in their own personal way. Why not just get on board?

  57. 57
    Fair Economist says:

    @Elie:

    I am sure that I am in the minority but I think that trying to jump to Medicare for all in one leap is politically unfeasible.

    That’s pretty much proven. A single-payer referendum was defeated overwhelmingly in Colorado (3-1 IIRC) and neither Vermont nor California was able to pass single-payer legislatively. Single-payer means about 70% of the country has to change their health care plan, and people just aren’t OK with that.

  58. 58
    ruemara says:

    The key problem is the loudest clamour over single payer is by folks who don’t know what single payer is besides medicare for all and can’t understand that it might not be the best choice.

  59. 59
    Cacti says:

    @Elie:

    Okay — you got me on the details of how. But the thought I was trying to illustrate remains true — countries use different vehicles for universal coverage. It is not all single government payer…

    Germany actually has 3 types of mandatory health insurance, per teh wiki, rather than one system of umbrella coverage:

    There’s basic health insurance, accident insurance that sees to anything incurred in the course of your employment, and long term care coverage for if you are no longer functionally independent.

  60. 60
    germy says:

    @Baud:

    it’s dismissed out of hand

    By who? The villagers? What do the polls say?

  61. 61
    FlipYrWhig says:

    @SatanicPanic: I dunno, maybe because “single payer” to the degree that it has any meaning at all kinda hints that everyone gets free health care forever, and they might not like it when they realize that they don’t?

  62. 62
    itstrue says:

    I see a lot of potential solutions baked into the Medicare system writ large. It’s worth noting that “Medicare for All” as Medicare’s currently formulated would include Medicare Advantage as an option. Also, you can call a system “single payer” both if it pays for care or if it pays for coverage. In the latter, taxes would go towards premiums for a mix of public or private coverage, like we already see in the Medicare system. Call it Medicare for All and you have a political winner.

    In practical terms, It’d be a matter of being free to pick what you want, which ought to please more market-oriented folks, not to mention private insurance carriers who know how to make a profit off of MA plans. The risk-adjusted per-member-per-month rate MA plans get from the Feds is also a powerful tool to hold down costs, arguably as powerful as simple government-provided coverage. It’s certainly better cost control than the status quo.

    If we financed our coverage through a default withholding (like the Medicare Payroll tax) we could allow people to simply elect a greater withholding to get more coverage, peg the withholding to household income in real time, subsidize where needed, and even create an opportunity to opt out altogether; something that I think is the only viable alternative to the dreaded Individual Mandate.

    For the end user it’s just a payroll deduction (or not), go online, pick your plan, and you’re done. For example, you can take a standard ‘1’ deduction, and you get any Silver plan you want, a ‘2’ buys any Gold, etc. Or pick ‘0’ and you’re on your own. Insurance companies receive a risk-adjusted “silver” or “gold” rate from Medicare, and then they compete on making your life easier through customer service and care coordination, instead of who is best at nickel-and-diming us.

    To address the plurality of Americans who get coverage from an employer, we could even look at employer contributions playing some role in the equation, since they’re already paying a chunk of the Medicare Payroll tax. We could alter or replace ERISA to slowly harmonize employer-sponsored coverage with Medicare Advantage standards so people wouldn’t experience serious disruptions. Employer plans would eventually be indistinguishable from Medicare Advantage plans, where you could stick with your coverage if you like it, and it’s funded by a payroll deduction like it is now, with some defined percentage coming from the employer and some from the employee. The cost of your individual “1”, “2” or “3” deduction would depend on your (possibly mandated, likely still tax-deductible) employer’s share, and your own income level. No employer coverage? Then the government pitches in extra.

    …Anyway, that’s what I’d do if I were the God of Health Care, and not His fearful subject.

    One way or another, I do think that political buy-in and the potential for disruption are essential variables to address at the outset of a discussion. We can’t just drop a brand-new system from the heavens and expect everything to go well. Even abiding by those principles, I think that Medicare for All or Single Payer are possible, at least if we broaden our conceptions of what the terms mean.

  63. 63
    Baud says:

    @germy: By everyone. I don’t know if there are any polls because there’s nothing to poll yet.

  64. 64
    gene108 says:

    @(((CassandraLeo))):

    I’m still not convinced that single-payer is necessarily more desirable than a public option, despite being well to the left of basically all elected Democrats. The thing is, there’s something to be said for not subjecting people to unwanted changes. If we change to single-payer, a lot of people are going to get changes to their healthcare that they didn’t ask for, and they may not like all of them. The public option would allow people to keep their coverage if they like it and buy into Medicare (or Medicaid) if they don’t – and merely having that option available would force private insurers to improve their coverage and efficiency in order to stay competitive.

    The issue won’t be consumer choice. We’re used to finding new doctors every few years, as employers keep changing insurance providers.

    The issue will be can providers manage with Medicare reimbursement rates?

    That’s the biggest issue, in my opinion, with single payer. How much money can you slash from healthcare spending, without seeing adverse effects on the number of people employed in healthcare, because I doubt you can have Medicare-for-all without reducing reimbursement rates to providers.

  65. 65
    Cheryl Rofer says:

    But at least there are some bills that can be criticized, unlike what the Republicans did. And there is time to work on them.

  66. 66
    FlipYrWhig says:

    @ruemara: “First we tell everyone that they get all their healthcare for free, which they’ll like, and then we use The Bully Pulpit to get doctors and hospitals and phárma companies to stop charging so much, easy peasy. People hate doctors and hospitals and lifesaving drugs, right?”

  67. 67

    @ruemara:

    The key problem is the loudest clamour over single payer is by folks who don’t know what single payer is besides medicare for all and can’t understand that it might not be the best choice.

    Or finicky details like “medicare has premiums” and “medicare has supplementary private insurance”

  68. 68
    pepper says:

    @Elie: I think the starting point for the discussion should be ‘universal access’, not ‘single payer’. if we can get folks on board with the idea that everyone needs access, then we can decide how to pay for it. i don’t think most people actually care who pays for it so long as they can get affordable quality medical care. i think the first step on the path is some kind of public insurance option with proper benefits and subsidies. maybe this is really expanded medicare in some form, but if everyone can opt in to a public program, then we aren’t as sensitive to changes in private insurance markets. if in fact the public plan was superior to private insurance, people would gravitate to it.

  69. 69
    Elie says:

    @SatanicPanic:

    Because when you get elected you then have to produce the result you ran on eventually. You end up in a world of hurt trying to finesse what must then become very specific. I think that is a very bad idea but I note your point that people want to call things what they like to call them. I personally am a little hesitant because I don’t trust Bernie or his peeps and their motivation — and they were the big drivers of using this “Medicare for all” terminology. I think its very dangerous for Democrats to jump on this “me too” train without thought beyond “Well if Bernie wants it lets not make anymore waves”.

  70. 70
    SatanicPanic says:

    @FlipYrWhig: Does it? I don’t think it means that.

  71. 71
    Uncle Ebeneezer says:

    @SatanicPanic: What I’m worried about isn’t the slogan itself, it’s the tendency of Leftists to make their preferred slogan/policy a hill-to-die on. We need every seat we can get in 2018 and I worry about these Leftists putting their time/energy/support towards some Green Party candidate who won’t get beyond 2% of the vote because the viable Dem candidate isn’t ready to jump head-first into pushing Single Payer. I worry about it not only for the sake of 2018, but also for unity and all the hard work that has to be done at every level fighting 45’s fuckery.

  72. 72
    Elie says:

    @pepper:

    I certainly think that makes sense and is one way to meet our goal of universal coverage…

  73. 73
    Baud says:

    @SatanicPanic: Single means one. That one is usually the government.

  74. 74
    SatanicPanic says:

    @Elie: I don’t think we need to follow the Sanders template. I think we can call it single payer, make some sort of expansion to the ACA, like, say, what Chris Murphy is talking about with allowing people to buy into Medicaid, call it single payer, and pat ourselves on the back. Yes, eventually you have to get specific, but that’s true anyways.

  75. 75

    @SatanicPanic: Gee, maybe we should pick a term with a clearer meaning that people can figure out on their own just by looking at the words.

  76. 76
    jl says:

    @tobie: Employer health insurance in Germany is very different from that in US. Most funding provided by employers is classified as public expenditure, the companies are viewed as administering the Social Health Insurance Law. If we tried to adopt the Germany system, I don’t think most companies would consider joint administration of a mix of public regional sickness funds and private company funds with a administrative board that includes employees to be the same system. Probably would work better, but not the same system.

    @pepper: I agree, except use ‘insurance coverage’ instead of ‘access’ because GOP has already converted ‘access’ into a bait-and-switch term of art for their swindles.

  77. 77
    Elie says:

    Let me also go back to emphasizing that we need to undo the immigration jam asap. We aint paying for anything big in the social safety net if we do not have the youngs in enough number for the future to support the thing…. I don’t see American women having 4 kids each as the alternative…

  78. 78
    SatanicPanic says:

    @Baud: I know what single means. I also people play fast and loose with the term Single Payer. Which is an opportunity for us.

  79. 79
    SatanicPanic says:

    @Major Major Major Major: So people can pin us down before we get a chance to negotiate? I don’t like that idea.

  80. 80
    Baud says:

    @SatanicPanic: I can see the attack ads now — single payer or 350 million Americans paying???

  81. 81
    FlipYrWhig says:

    @SatanicPanic: Of course it does. The appeal of the two-word slogan (which is still bad) is that if we had it then the government would pay for everyone’s health care “like in Europe.” And when doubters say “wait, but wouldn’t that be really expensive?” it’s supposed to be a winning argument to say “no, it’ll only cost what you’re already losing from your paycheck for your health plan at work, so it’s a wash.”

  82. 82
    Schlemazel says:

    We could not get a majority of either House interested in single payer in ’08, why does anyone think that is better now? This is just so much window dressing like 70 votes to repeal, it means nothing. These jokes will have no impact on what finally passes because the specifics will be worked out based on vote counts, just like they were for ACA.

  83. 83
    Insane Clown POTUS says:

    We need to call the single payer or universal coverage bill the “Obamacare Repeal and Replacement Act”. Let the bastards argue against Obamacare Repeal and Replacement.

  84. 84
    Elie says:

    @Major Major Major Major:

    Yes — this. Taking the analogy back to Mars, its the boulder field no one saw or planned for as the lander tries to find where to set down….

  85. 85
    Uncle Ebeneezer says:

    @Insane Clown POTUS: Thank you. I needed that laugh.

  86. 86
    Betty Cracker says:

    @gene108: Undoubtedly true that some people want to destroy for-profit health systems as part of a broader effort to unravel capitalism. But others recognize that while capitalism works fine and dandy for some things — development and distribution of washing machines, chewing gum, automobiles, hair care products, etc. — it sucks when applied to a system wherein the customers (patients) don’t have the time and/or knowledge to fully understand their options and seek bargains.

  87. 87
    SatanicPanic says:

    @FlipYrWhig: “Government handles your insurance if you want it to”

  88. 88
    Jim, Foolish Literalist says:

    I think Medicare for all is broad enough to include “access to Medicare for all”, i.e., Medicare buy-in as a public option. It would still be complicated and a tough sell, but it would make it harder to sell it as entitlement, welfare et cetera

  89. 89
    pepper says:

    @jl: fair enough. Universal coverage is a fine goal. to me, the biggest issue with ‘single payer’ isn’t any problem i have with it as a program. it’s that the words are loaded. folks hear the term ‘single payer’ and get bent out of shape. and we get into discussions/arguments about supporting bernie sanders or not supporting bernie sanders. this is stuff that i think distracts from we should concentrate on, which is getting people covered. if we can change the discussion to addressing coverage and not who writes the check, i think that would help. there is time to sort out the policy details.

  90. 90
    Baud says:

    @SatanicPanic: That’s a public option.

  91. 91
    FlipYrWhig says:

    @SatanicPanic: I like the sound of that plan but it’s not “single payer” either by the denotative or the connotative meaning of either of those two words. We could have “primary, preventive, and urgent care for all.”

  92. 92
    gene108 says:

    @Elie:

    I am hoping that folks begin to see that as the goal rather than the knee jerk “Medicare for All” mantra. I know that its catchy and sounds like a nice slogan that everyone understands, but it is very misleading by making people think its just an easy solution.

    Medicare is complicated. It takes time to figure it out, once you are introduced to it. But once you are on it, you just need to renew.

    From the outside, people just see old folks renewing every year. They don’t understand all the options old folks need to deal with, when they first sign up.

    I think setting expectations is really going to be key in successfully pulling off Medicare-for-All, because too many people want free healthcare, where they don’t pay a thing other than taxes (if that) and think that’s what single-payer will be.

  93. 93
    SatanicPanic says:

    @Baud: It’s Single Payer if we want to call it that.

  94. 94
    SatanicPanic says:

    @FlipYrWhig: It’s single payer. like Medicare.

  95. 95
    Baud says:

    @SatanicPanic: Sure. We can still call it Obamacare if we want to.

  96. 96
    SatanicPanic says:

    @Baud: Nah, he’s in the past. Harriscare or Gillibrandcare, or Sanderscare, depending on how the 2020 primaries go.

  97. 97
    FlipYrWhig says:

    @SatanicPanic: How about just “free clinics for all”? Put one next to every post office. Call it “US Health Service” or something. We’d need thousands and thousands more doctors and nurses but, hey, whaddya know, there’s all kinds of unemployed and underemployed people!

    I just really hate the branding.

  98. 98
    jl says:

    @gene108: @Betty Cracker:

    Fact is that, as far as I know, not one country with a successful health care system, in terms of cost control and population health and customer satisfaction, allows for-profit free enterprise to run the core function of providing basic minimum insurance coverage. That just does not work. Not even Switzerland, which is goal we need to have if we decide to go with PPACA rather than Go Australia with medicaid for all. Even the supposedly ‘private enterprise’ Netherlands system has been called ‘hidden single payer’ because of the vast publicly run subsidy and risk adjustment system that spreads around huge amounts of money in that country. I don’t know whether someone told Arnie about that when he decided Netherlands would be the model of his abortive CA health care reform effort.

    So, fine to worry about the salesmanship, but the rest of the world seems to be telling us that ‘for-profit’ free enterprise model won’t work for basic coverage. Just doesn’t happen. Unless, like Netherlands, it turns into dressing up private entities that take a highly regulated cut for administering the dispersal of funds as a free enterprise for-profit system.

  99. 99
    ruemara says:

    @FlipYrWhig: Bingo. I can’t wait for you to tell a doctor with a $200k medical school loan that he needs to accept what works out to a $15 per hour wage if he accepts medicare clients.

    @Major Major Major Major: Double Bingo. Most have ZERO experience with socialized medicine. Having sat for hours to be seen by my indigent medical care hospital provider while, I dunno, dealing with a blood clot and heavy bleeding from being on thinners too long, I have some freedom from illusions.

    @Elie: Think of this more as heading the Bernista assault on anyone who might be a reasonable challenger to Bernie wave off at the pass.

  100. 100
    FlipYrWhig says:

    @SatanicPanic: You’d need to make the premiums and copays quasi-invisible (like payroll tax) or zero. If anyone ever sees a bill it’s going to unleash more butthurt than any nation’s health infrastructure can tend.

  101. 101
    SatanicPanic says:

    @FlipYrWhig: It’s not my favorite two words either, but it’s not a hill I want to die on. If someone comes up with something better I’m OK with that.

  102. 102
    Mike J says:

    @Barbara:

    I think working on the details sooner rather than later is a good idea. What bothers me most are people who basically know nothing about Medicare assuming that it provides the best model for universal access to health care.

    I cannot tell you how many Democrats I met during the last election who were gung ho to repeal and replace because Obamacare deductibles were too high and thus useless to poor people, and how many of those same people believe that Medicare fore all, with it’s 80% payment is great.

    Aren’t insurance companies required to pay out at least 80% of premiums for medical costs?

  103. 103
    SatanicPanic says:

    @FlipYrWhig: Why? I had copays in Japan, they were like $15. That almost made me feel better about the whole thing because I thought I was getting a discount.

  104. 104

    @SatanicPanic: “universal coverage” is fine

  105. 105
    jl says:

    @pepper: I think we agree that something like ‘adequate insurance coverage, or ‘universal coverage’ is a far better buzzword. And just getting to that goal solves a lot of problems in itself.

    @Yutsano: ERISA will have to go away to get any of the lofty single payer goals. I think it might be worthwhile to revise it as a stand alone reform. Could be useful to provide more flexibility for state reforms without resort to waivers.

  106. 106
    gene108 says:

    @Betty Cracker:

    it sucks when applied to a system wherein the customers (patients) don’t have the time and/or knowledge to fully understand their options and seek bargains.

    The bigger problem with healthcare, rather than just understanding, is you don’t have a lot of options.

    Option 1: Go on dialysis because your kidneys don’t work good. It’ll be expensive.

    Option 2: Die a slow and agonizing death.

    There often aren’t a lot of options for people, with health problems, so a lot of free-market-assume-competition-can-exist dynamics fall apart.

    But others recognize that while capitalism works fine and dandy for some things

    I think the idea of capitalism is separate from markets in this case. Healthcare is a very non-price sensitive market. You can have access to life saving treatments or hope you don’t die. There’s not a lot of inbetween for many people.

    Capitalism is about making money. The question is should people be making fortunes off of providing healthcare? And what is a fortune?

    Can we provide affordable access to healthcare and still have people making money off of it? And mind you, what we pay for services translates into what doctors, nurses, hospital administration, insurance company administration, medical device makers employees, etc. get paid.

    Doctors, in some ways, make a small fortune practicing. They make more here than in other countries. At what level do we say, enough is enough, with regards to people making money off of providing healthcare services.

  107. 107
    SatanicPanic says:

    @Major Major Major Major: OK, but you don’t have to convince me, it’s the Bernistas you’ll have to talk into adopting this language. TBH I don’t care, I just don’t see any point in picking a fight over a term that works OK.

  108. 108
    Elie says:

    @gene108:

    Ahhh — those details…

    If we had Medicare for All, enrollment would be constant as it would cover births, child care and every point including old age. Should it cover nursing home care? How about plastic surgery? What about experimental care?

    There is a lot of detail to cover here — and we should not short change that in thinking about means to do this. That is why I advocate tinkering with Obamacare as a transition into chunking in some sort of public pay option instead of the very misleading term “Medicare for All”.

  109. 109
    jl says:

    @jl:

    Go Australia with medicaid for all. should be ‘Go Australia with medicare for all’

  110. 110
    Another Scott says:

    @JCJ: Dunno about outsourcing, but I would want to see actual experts from the UK, Switzerland, Germany, Norway, Japan, SK, etc., be invited to testify before the relevant House and Senate committees and at Presidential Rountables (or whatever), along with getting input from experts and stakeholders and common people in the USA. We need to know how others handle corner-cases, how they handle their aging populations, what they plan to do when AI-Takes-All-The-Jobs / Companies-Can’t-Find-Enough-Qualified-Workers, etc., etc.

    Reinventing the wheel isn’t a sensible option, but neither is intentionally ignoring other countries’ experiences.

    If it just becomes a battle of sound-bites, then we could be in for a world of hurt when the Teabaggers (and Vlad) reanimate Harry and Louise. :-(

    Cheers,
    Scott.

  111. 111

    @SatanicPanic: I don’t have any interest in even talking to them, but in my personal writings I’m going to keep distinguishing between mechanisms and goals. I am very wary of giving in to a single one of their ‘harmless’ demands though, since they don’t have a good track record.

  112. 112

    @Mike J: Traditional Medicare pays 80% of allowed charges and you are stuck with 20% out of pocket with no cap. That is a huge flaw if you are very sick. If you have a pretty healthy year or even a $15,000 year, you come out ahead with Medicare than if you have a Bronze plan with a $7,000 deductible.

    Medicare, all said and done, has an actuarial value of about 84%. ACA on Exchange coverage has an AV of about 84% once you factor in CSR. The incidence of cost sharing varies by illness burden as the sick/expensive pay more in Medicare and the mostly healthy pay more on Exchange on average.

  113. 113
    SatanicPanic says:

    Guys, how much of this opposition to Single Payer as a term is just trying to stick it to Bernistas? cause let’s be real, that’s a bit silly.

  114. 114

    @SatanicPanic: I think it’s important to recognize early on that our universal coverage mechanism might not be single-payer in the end, and keep our eyes on the prize rather than preemptively ceding implementation details for no reason.

  115. 115
    SatanicPanic says:

    @Major Major Major Major: That’s the beauty of the words Single Payer, there are no details

  116. 116
    Elie says:

    @SatanicPanic:

    No, dude… there is substance in the concern — not just resentment towards Bernie. Have you read or do you believe anything that has been posted as the “why” Medicare for all is problematic? If you read it and understood it, you would not be asking whether its just resentment against Bernie.

    Look, 2018 is very, very important to Democrats and saving this country, and we can’t fuck it up or we are stuck with the Trump hurricane storm surge for a long time. I take our mission very seriously. Too seriously to just be against Bernie “because”. I think that Medicare for all is fraught with all sorts of pitfalls for us and does not describe in the use of that term the real goal — which is universal coverage or health care for all Americans. We have to be flexible and quick on our feet using a variety of tools not just adopting “Medicare for all” because its the only hammer in our toolbox.

  117. 117
    jl says:

    @SatanicPanic: The Hillary/Bernie feud must never be allowed to die.
    People who don’t like ‘single payer’ should just tell the Bernie fanatics you are going with the ‘health care is a right’ buzzword and they can shut up.
    Hillary fanatics can while away the time fiddling with nano-micro reforms to PPACA in order to preserve Obama’s legacy in amber (as if Obama’s legacy cannot take care of itself).

  118. 118

    @SatanicPanic: How are there no details? Single-payer is a detail.

  119. 119
    SatanicPanic says:

    @Elie: I think you’re missing the point. We can say “we support single payer!” now and 2-3 years from now when we’re in a position (I hope!) to produce something, we don’t HAVE to go with Medicare for All. We could easily do something else. At that point who’s going to argue? Medicaid for all, or public option, or whatever. Doesn’t matter. We could call any of them single payer.

  120. 120
  121. 121
    SatanicPanic says:

    @Major Major Major Major: Not in any way that matters. How do I read threads full of people going “Americans don’t understand healthcare” and “Bernistas support single payer without knowing what it means” and then get people going “you can’t say single payer, people will lock you into this one particular definition!”?

  122. 122
    jl says:

    @Baud: Your home work, young man, is to go through every comment and check that.

  123. 123
    SatanicPanic says:

    @Baud: Color me skeptical.

  124. 124
    Baud says:

    @jl: no. The comments here have been mostly substantive.

  125. 125
    Elie says:

    @SatanicPanic:

    Ok. I still have a hard time with the term. Why can’t we improve what we already have with ACA? Why do we have to advocate for a whole separate new effort? Its like we would be throwing out what we have already that we could build on? Why can’t we respect the success we already have and use that as a starting point? Do you think we should repeal ACA and replace it, after all? What message are the democrats sending when they willingly abandon their own existing solution so completely that it sounds like the Republican pitch to repeal and replace.

  126. 126
    Baud says:

    @SatanicPanic: I don’t care. Obviously, we can’t even have a substantive discussion on Day T-1.

  127. 127
    jl says:

    Single payer can mean a dozen things, ten of which will work well,
    Rather than piss on it and condemn, better to suggest better alternatives and persuade.

    I like ‘universal coverage’ and ‘health care is a right’ better and I will see how well i can sell them to any single payer fanatics I run into.

    Edit: And I don’t see a big problem with bargaining for incremental improvements with single payer as the main alternative, rather than repeal and replace.

  128. 128

    @SatanicPanic:

    How do I read threads full of people going “Americans don’t understand healthcare” and “Bernistas support single payer without knowing what it means” and then get people going “you can’t say single payer, people will lock you into this one particular definition!”

    These are all saying the same thing–Americans don’t understand how healthcare is delivered.

    I think it’s important that we understand the distinction between our goals and the ways we achieve those goals. In my experience it’s the only way to really achieve them at all. And the way we talk about something not only indicates the way we think about it, but it shapes it, too. This is important.

  129. 129
    SatanicPanic says:

    @Elie: I think we should do all of those things. My ideal would be to create a public option, say “look everyone, we now have single payer!” and call it a day.

  130. 130
    Miss Bianca says:

    In the comments to this article I found a link to this “Cracked” article, which I loved so much I almost suspected that our own Richard David Mayhew-Anderson had written it, instead of this whasname Charles Gaba…the “Zero BS Guide to American Healthcare”. he talks a lot about the problems we ran into in Colorado trying to get a single-payer system passed.

    http://www.cracked.com/blog/a-.....ealthcare/

  131. 131
    SatanicPanic says:

    @Major Major Major Major: Well we’ll have to differ on that last part. I think “Single Payer” is a nice term that we can hop on board with and use for our ends. There’s no point in getting into a food fight over it and I, for one, can see we’re going to lose this particular battle, since our 2020 frontrunners have already decided to do exactly what I suggest we do. At this point “if you’re explaining you’re losing” starts to become relevant.

  132. 132
    Insane Clown POTUS says:

    @Uncle Ebeneezer:
    I’m not even kidding. The Republicans know how to do messaging. Calling universal coverage “The Obamacare Repeal and Replacement Act” would short circuit that. Twitler would sign it in a second.

  133. 133
    msdc says:

    @gene108:

    How much money can you slash from healthcare spending, without seeing adverse effects on the number of people employed in healthcare

    Or without seeing adverse lobbying from the people employed in healthcare.

    Nurses, doctors, and pharmacists are some of the most trusted professions in America. Members of Congress are dead last. What happens when health care providers (backed up by insurers) start shelling out for “Harry and Louise”-style ads against single-payer?

  134. 134
    Monala says:

    @Major Major Major Major: I think this is a HUGE issue. It seems like a lot of the “single payer” or “Medicare for All” advocates here in the U.S. think this means, “no out of pocket costs for healthcare consumers ever.” They don’t realize that Medicare recipients pay premiums, or that it only covers 80% of costs (hence the need for supplemental insurance), and they don’t realize that premiums and cost-sharing are a part of many of the universal healthcare programs in other countries.

  135. 135
    japa21 says:

    @Monala: And as David mentioned, there is no cap with traditional Medicare. In fact, for many people Medicare is not a single payer system. For example, there are dozens of Medicare Advantage plans, some of which provide better benefits than Medicare. Also, I would suspect a majority of people on Medicare also have a Medicare supplemental plan.

    And, of course, traditional Medicare does not cover drugs, and if it did, the cost in premiums would be much higher. Most Medicare Advantage plans do cover drugs.

    My point being, even things which are considered single payer are not single payer.

  136. 136
    Kathleen says:

    @Elie: Amen! I, too, believe the goal is universal coverage, not “single payer”. Incremental change is needed.

  137. 137
    Kathleen says:

    @gene108: I was wondering about the same thing regarding willingness to pay for Medicare. I’m on Medicare and there are doctors who don’t want to treat Medicare patients.

  138. 138

    […] David Anderson’s post at Balloon-Juice got me thinking on single payer vs. universal coverage — I’m with David (and Elie). Don’t care how we get to health care for all Americans, as long as we get there. […]

  139. 139
    Uncle Ebeneezer says:

    @Insane Clown POTUS: And then buried somewher in tiny print: “24 hours after signed by POTUS, will formally be known as the ‘Obama Was The Greatest President Ever Act.'”

  140. 140
    Insane Clown POTUS says:

    @Uncle Ebeneezer:
    Yeah, or record Obama suggesting it should be called that, but hold back the video until after it is signed.

  141. 141
    Davebo says:

    If the goal is universal coverage then getting the cost of healthcare under control is critical.

    I’m not sure single payer is the only way to accomplish that but it’s the only one I know of.

  142. 142
    Davebo says:

    @japa21: Part D covers a lot of drugs.

  143. 143
    chopper says:

    @SatanicPanic:

    We can say “we support single payer!” now and 2-3 years from now when we’re in a position (I hope!) to produce something, we don’t HAVE to go with Medicare for All. We could easily do something else.

    that “easily” is doing some heavy lifting. I’m not going to get into some anti-berniac screed here, but if we agree in general principles to “single payer soon” and then years later start working out the details and the bernie wing doesn’t like it there’s gonna be a lot of “kill the bill” bullshit from them. honestly I think it’s better to work out an agreeable, at least somewhat detailed plan to start with.

  144. 144
    EricNNY says:

    Rearranging winners and losers: the people vs. insurance companies. There are enough of us out here that have had to go to war with an insurance company that wrongly denied a claim that it should be a no-brainer. Pharmaceuticals? Only politicians who get huge campaign money care about them. Most hate hospitals unless they’re one of the few non-profit or seriously wealthy ones that don’t turn people over to collections for a missed payment. Doctors? Take some of the money we’d save from insurance to subsidize med school.

  145. 145
    goblue72 says:

    Screw you. Those who pushed for the politically smart move of a “keep it simple stupid” framework for the voters – “Medicare for All” or some variation thereof – and who understand the advantage of staking out a clear – and bold – position of truly universal coverage that was also a lot more straightforward than ACA Rube Goldberg machines – are winning. And wonks like yourself who continually crab that the Medicare for All folks are the dumb ones – and the Rube Goldberg ones are the only true holders of knowledge – and getting pants-ed in public.

    Its long past time for you to apologize and eat some well deserved crow. You won’t – I get it. But it don’t mean you ain’t being pantsed.

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  1. […] David Anderson’s post at Balloon-Juice got me thinking on single payer vs. universal coverage — I’m with David (and Elie). Don’t care how we get to health care for all Americans, as long as we get there. […]

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